Long-term non-progression in children with HIV: estimates from international cohort data
A recent study published in AIDS, Jackson et al. examined data from 13 European countries and Thailand through the European Pregnancy and Paediatric Infections Cohort Collaboration (EPPICC) to estimate the probability of long-term non-progression (LTNP) in the absence of ART, using historical cohort data collected before universal ART guidelines.
The main analysis included 2481 domestically born children from six national cohorts. LTNP was defined as surviving to age 8 without ART or clinical/immunological disease progression. Using WHO immunosuppression thresholds, the probability of LTNP at age 8 was 10% (95% CI: 6–15%) among those born between 2004–2007, and up to 19% among those born before 1997. Declining LTNP probability over time mainly reflected earlier ART initiation due to changing guidelines, rather than increased disease progression.
Of 290 children meeting LTNP criteria at age 8, only 7 remained ART-naive and progression-free by age 18. Elite viral control (defined as sustained undetectable viral load without ART) was rare—only two children met this definition before age 8, and two more after. LTNP was more common among females and children from the UK/Ireland cohorts, and less likely among those born in more recent years.
In summary, while rare, LTNP does occur in a minority of children with perinatal HIV. These findings support the identification of LTNPs for research into post-treatment control and HIV cure.